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Carcinoma ex pleomorphic adenoma presenting in the nasopharynx is extremely rare. We present a case of carcinoma ex pleomorphic adenoma occupying the nasopharynx and the soft palate in a 51-year-old woman. To the best of our knowledge, this is the first reported case of carcinoma ex pleomorphic adenoma in the nasopharynx.

A 71-year-old man was first diagnosed with primary transitional cell carcinoma of the prostate with a skip lesion on the distal urethra. The patient received three courses of intra-arterial chemotherapy of cisplatin (CDDP) and pirarubicin (THP-ADM) followed by a radical prostatectomy. Histopathologic examination of the prostatectomy specimen revealed adenocarcinoma invasion along the prostatic duct extending to the peripheral acini, which was diagnosed as ductal adenocarcinoma. The clinical and histopathologic features of this case are entirely different from usual adenocarcinomas of the prostate. This rare histopathologic feature should be recognized as 'ductal carcinoma of the prostate', to distinguish it from papillary adenocarcinoma or adenocarcinoma with endometrioid features. The patient has had no sign of recurrence 14 months after the operation. CDDP-based chemotherapy followed by radical prostatectomy may be one of the promising therapeutic modalities for this rare entity.

Three-dimensional (3D) reconstruction and morphometry of resected colonic adenomas were undertaken to extend current knowledge of clinically significant features such as the frequency of occurrence of cancer, and the size and spatial distribution of dysplastic zones in these tumours. Fifty endoscopically resected colonic adenomas were serially sectioned at intervals of 0.2 mm and the sectional images were loaded into a computer system in order to visualize the spatial distribution of dysplastic zones. These were graded into five groups according to the criteria of Morson and Dawson: normal mucosa, mild dysplasia, moderate dysplasia, severe dysplasia, and cancer. The way in which zones of different grades are distributed in a polyp was visualized in a computer display and the volume of each dysplastic zone was estimated by the Cavalieri principle. In five polyps, adenocarcinoma was found growing in an adenoma. In all of these, the cancer was surrounded by less dysplastic zones, in the form of 'cancer in adenoma'. In pedunculated polyps, submucosal invasion could occur even if the volume percent of severe dysplasia was less than 10%. In such a case, multiple biopsy specimens are advisable. Semipedunculated polyps smaller than 200 mm(3) can also harbour submucosal invasion. In this study it was found that if the adenomas had been examined by only a single section, as many as one in five of the cases in which submucosal invasion had already developed would have escaped microscopic confirmation. To prevent such diagnostic failure, it is advisable to add a few deeper sections. Thus, 3D reconstruction and morphometry have been helpful in establishing a better standard for the diagnostic histopathology of colonic tumours., (Copyright 2000 John Wiley & Sons, Ltd.)

Emergency surgery for bowel perforation caused by metastases from lung cancer is rare. Two cases of small bowel perforation due to metastasizing lung cancer are reported. Both patients were admitted as a surgical emergency case. One of the two patients presented herein survived and was discharged from the hospital. Perforated small bowel due to metastatic lung cancer is a highly fatal event that occurs in the late phases of the disease. Despite the poor prognosis, early and appropriate therapy will occasionally yield successful surgical palliation. Patients with known lung cancer who develop abdominal complaints should be examined thoroughly and treated quickly.

Atypical adenomatous hyperplasia (AAH) of the human lung is considered a possible precursor of pulmonary adenocarcinoma. However, its true biological significance remains to be clarified. The authors studied the ultrastructure of AAH in surgically resected lungs and compared it with that of coexisting adenocarcinoma in an effort to define the characteristic features of AAH. Ultrastructurally, AAH possessed oval to irregular nuclei with high nucleo-cytoplasmic ratio and large nucleoli. Development of cytoplasmic organelles was generally poorer in AAH than in adenocarcinoma. However, these differences became less apparent as the degree of atypia of AAH advanced. Both lamellar bodies and electron-dense granules were found in AAH as well as in adenocarcinoma. These results suggest a close relation of AAH with adenocarcinoma of type 2 pneumocyte or Clara cell type. Further, the results of immunohistochemical studies for surfactant apoprotein A, urine protein 1, cytochrome P-450s, CEA, p53, c-erbB-2, Ki67, and bcl-2 well reflected the ultrastructural findings. These results suggest, in accordance with previous studies, that AAH is a lesion closely related to adenocarcinoma. Further, AAH shares some characteristics of type 2 pneumocytes and Clara cells, implying that it might be derived from their common precursor.

Background: In a previous study, morphometry and multivariate cluster analysis was performed on 97 lesions. These consisted of atypical adenomatous hyperplasia (AAH), considered to be an important lesion corresponding to a step of carcinogenesis for adenocarcinoma of the human lung, Clara cell type, and type 2 pneumocyte type adenocarcinomas. Although AAH and the two types of adenocarcinoma were re-classified into three clusters and AAH was defined in clear morphologic terms, the biologic nature of AAH has yet to be clarified. In the present study, immunohistochemical analysis was performed to gain a deeper understanding of the relationship between AAH and the two types of adenocarcinoma, and to compare the results with those obtained by morphometry., Methods: The 97 lesions analyzed by morphometry were submitted to immunohistochemical analyses using antibodies against surfactant apoprotein A, urine protein 1, carcinoembryonic antigen and cytochrome P-450s (1A1-2, 2B1-2, 2E1). Also examined, as controls, were 17 lesions with adenomatous hyperplasia (AH), a non-neoplastic reactive change of bronchiolo-alveolar cells, 30 areas of normal Clara cells, and 36 areas of normal type 2 pneumocytes. The immunoreactivity was graded by introducing a semi-quantitative scoring system., Results: Immunohistochemically, AAHs behaved quite similarly to the lesions classified as Clara cell type or type 2 pneumocyte type adenocarcinomas. For any of the antibodies employed, no significant difference in immunoreactivity was demonstrated among these lesions., Conclusions: The results suggest, in accordance with our previous morphometry, that AAH is a lesion closely related with Clara cell type and type 2 pneumocyte type adenocarcinomas, probably as their common precursor. However, the two types of adenocarcinomas, despite their characteristic morphologic features, are indistinguishable using the biological indicators applied in this study.

The adenocarcinoma sequence of the human colon is usually divided into three separate steps according to the grade of epithelial dysplasia, i.e., adenomas with mild, moderate and severe dysplasia. In an attempt to re-examine whether or not this sequence can be morphologically separable as usually assumed, a total of 192 epithelial lesions including adenomas with various grades of dysplasia were analyzed, relying on morphometrical and multivariate-statistical techniques. Histologic features of epithelial lesions were characterized by 10 quantitative parameters and subjected to 10-variate cluster analysis. In the result of computations, separation of neoplastic lesions into different groups proved to be rather ambiguous, not justifying the classification into three groups as generally expected. It was concluded that adenocarcinoma can develop from adenoma as a seemingly continuous process which may involve more steps than usually assumed.

Aims: To analyse the current state of endometrial cytology practice by determining the interobserver variability in grading the atypicality of endometrial cells using kappa statistics., Methods: A series of 70 clusters of benign, hyperplastic, and malignant endometrial cells on cytology specimens were examined by 19 experienced Japanese cytopathologists. They assigned each cluster to one of three diagnostic categories according to increasing cellular atypicality: negative for, suspicious of, and positive for malignancy. Each observer used their subjective judgement in grading without receiving any discriminatory criteria., Results: Most classified the series of 70 clusters of endometrial cells into 33 negative, 20 suspicious, and 17 positive grades. However, observer variation was considerable, kappa statistics showing unfavourable overall agreement (kappa = 0.36). Although there was good agreement on negative and positive (kappa = 0.46 and 0.47, respectively), poor reproducibility occurred in grading suspicious ((kappa = 0.15)., Conclusions: Currently, Japanese cytopathologists are not reliable in grading the atypicality of endometrial cells. This could be attributed mainly to the situation in endometrial cytology practice in which there are no generally accepted criteria for defining cells in which malignancy is suspected.

A method of quantitatively analyzing the distribution pattern (DP) of nuclei was introduced and applied to the differential diagnosis between hyperplasia and carcinoma in endometrial cytology. The DP of nuclei can be defined mathematically by [formula: see text] (DP index), where r is the mean distance between nearest nuclei and n0 the number of nuclei per unit area. The DP index has a limited range of decreasing values from 1.074 to 0.5, indicative of regular to random patterns of nuclear distribution. The estimated DP index (mean +/- standard deviation) was 0.826 +/- 0.029 in 23 normal cases, 0.735 +/- 0.019 in 17 cases of adenomatous and atypical hyperplasia, and 0.636 +/- 0.042 in 18 cases of well-differentiated adenocarcinoma. The DP index was significantly different between these three conditions (P less than 0.01). This result indicates that the endometrial epithelial cells lose their normally regular arrangement in the development of neoplastic change, approaching a random arrangement. Quantitative detection of this architectural change with the use of the DP index can facilitate differential diagnosis between hyperplasia and adenocarcinoma in cytologic specimens of the uterine corpus.

A quantitative method of evaluating the pattern of distribution of nuclei within a cell cluster was developed and applied to endometrial cytology. The distribution pattern (DP) is mathematically expressed using a "DP index," which can be determined as a product of the square root of the nuclear density, square root of n0, and the mean distance between the two nearest nuclei, r. The DP index has a limited range of decreasing values from 1.074 to 0.5 to 0, indicative of regular, random and aggregated patterns of nuclear distribution, respectively. The estimated DP index was 0.831 +/- 0.031 (mean +/- standard deviation) in the clusters of normal endometrial epithelial cells from 16 nonneoplastic cases, but 0.638 +/- 0.041 in malignant epithelia from 19 cases of well-differentiated adenocarcinoma. The index of normal epithelia was close to 0.877 of the regular hexagonal distribution pattern. Contrary to this, the DP index was significantly smaller in well-differentiated adenocarcinoma (P less than .001), approaching 0.5, the theoretical value of a random distribution pattern. These findings suggest that quantitative analysis of the distribution pattern of nuclei can be a useful aid in the cytodiagnosis of endometrial lesions.

In a demographic and histologic study of 200 intraoral minor salivary gland tumors seen in Japan (Nagasaki and Miyagi prefectures), 127 cases (63.5%) were classified as benign, comprising 124 pleomorphic adenomas and 3 monomorphic adenomas. The other 73 cases (36.5%) were malignant tumors, represented by 33 adenoid cystic carcinomas, 16 mucoepidermoid carcinomas, 10 carcinoma in pleomorphic adenomas, 6 acinic cell carcinomas, 5 adenocarcinomas, one polymorphous low-grade adenocarcinoma, one undifferentiated carcinoma and one clear cell carcinoma. There was an overall female preponderance (1.78/1). The mean age for females was 47.2 years and for males was 50.6 years. The mean age for patients with malignant tumors was 10 years greater than for patients with benign tumors and was statistically significant. The palate was the most common site for intraoral minor salivary gland tumors followed by the lip and buccal mucosa. These three sites accounted for 83% of all cases. Tumors arising in these three sites were predominantly benign. In contrast, those located in the gingiva, floor of the mouth and tongue were predominantly malignant. The results of this study were compared with other recent studies.